Kathryn M. Stadeli

Anecdotally, trauma surgeons know that at-risk traumatically injured patients often have poor dentition and oral health, and there is a correlation between poor oral health and fewer social resources and support, or social vulnerability, which can significantly impact health outcomes.

In the USA, traumatic injury results in a significant financial burden, which is unevenly distributed in our society. In this paper, we will highlight some of the data around the costs of injury associated with a focus on socially vulnerable and historically resilient groups at risk for disparate outcomes. We delve into the concept of economic return on investment from multiple perspectives: the patient perspective, the community perspective and from a national and policy perspective. Targeted policy changes and dedicated efforts towards minimizing gaps in trauma care and enhancing survivorship can yield substantial economic benefits. This paper also describes several national funding agencies and their current priorities related to funding in equity and trauma research. This manuscript will demonstrate that reducing disparities in trauma care not only serves a moral imperative but also a necessary and financially sound strategy with a good economic return on investment.

Despite remarkable advances in clinical care, injury remains a leading cause of death in the USA. Recent studies in the care of the injured patient have begun to unearth the crucial influence of health disparities and health inequity on outcomes after injury. Importantly, it is known that there are strikingly disparate outcomes following injury based on demographic backgrounds, with racial and ethnic minoritized groups having a higher risk of death from traumatic injury. This paper highlights the problem of health inequity after injury by addressing health and health care disparities in trauma with a focus on the proceedings from the Summit on the Advancement of Focused Equity Research in Trauma organized by Coalition for National Trauma Research’s Equity, Diversity and Inclusion Committee. Included in this work is an assessment of the structural determinants of health inequities and the evidence for widespread inequities across the continuum of trauma care; with an emphasis on five vital, actionable steps towards health equity that can be taken now by the trauma community, including firearm injury prevention, Medicaid expansion, trauma-informed care, equity measurement and benchmarking, and improving trauma survivorship. Ultimately, to move towards improved quality of care for all injured patients, we must eliminate health care disparities in trauma care across the continuum and work towards more equitable care for all.

Trauma research is an expansive discipline that informs injury prevention, best practices in care, and novel interventions. However, implicit bias, or the unconscious stereotypical beliefs about groups of people, can have profound implications for traumatic injury research. Several forms of implicit bias can emerge in trauma research, which deepens existing disparities based on race or ethnicity, sex, ability status, socioeconomic status, and other factors. This paper reviews how implicit bias affects the development of research and the application of findings, potentially leading to suboptimal care and misdirected preventive strategies in trauma. We present the recent dialogue and progress on implicit bias in research at the Summit on the Advancement of Focused Equity Research in Trauma (SAFER-Trauma) conference, an Agency for Healthcare Research and Quality-funded assembly of multiple disciplines which was convened to tackle the challenges involved in addressing disparities in traumatic injury. Through this review, we seek to generate momentum for action toward reducing implicit bias and establishing comprehensive equity-focused standards of trauma research and practice.

On August 2–3, 2023, the Summit on the Advancement of Focused Equity Research in Trauma (SAFER-Trauma) convened to discuss strategies to support research to eliminate disparities in trauma care. An ongoing challenge for performing high-quality equity-based research is the uncomfortable recognition that implicit bias and structural racism are deeply ingrained in our society and culture and are therefore often unrecognized in medicine and research practices. Throughout SAFER-Trauma, several examples of strategies to overcome these challenges were presented. In this article, we will relate a diverse array of examples through three distinct angles. The first focuses on innovations that harness existing data in novel and groundbreaking ways, uncovering fresh insights and applications from information already at our disposal. The second examines innovations that arise from traditional healthcare systems and research methods, showing how research in the healthcare sphere can adapt to meet modern needs. The third will explore projects that emerged from communities, driven by the pressing needs and aspirations of the people they serve.